Ask a neurosurgery resident anything

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Oh it varies. Mostly journal articles or things for my next days cases. I follow SDN or other forums. For actual books, lately, I tend to be in to history. Given the wealth of books available and limited amount time, though, finding one I'll enjoy can be the hardest part because of the opportunity cost reading a book I'm not enjoying.

For what it's worth, if you're into history but don't have the time to search for a good book, I'd recommend The Gene by Siddhartha Mukherjee and Sapiens by Yuval Noah Harari. Hillbilly Elegy and The Last Lecture by Randy Pausch aren't historical books per se (both are memoirs) but still belong. TBH I should be a professional book reviewer instead of a physician.

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Undergrad: If you can do research now it helps set the groundwork for both medical school and residency applications. You have more time and leeway to learn how to do things. Do well on the MCAT and get in to the best/cheapest medical school you can. A medical school with a neurosurgery program, though not imperative, is more desirable than one without because it can be your launch pad to getting a residency.

Medical School: Do well in preclinical classes. If you have grades/honors, try to do well. Step 1 is the great equalizer, do the best you can. Third year rotations are again important, notably surgery. While a letter from the surgery chairman is not necessary, having honors in surgery looks good. Most applicants have some sort of research project during medical school. These range from a case report to a clinical study. If you know you want to do neurosurgery early, get involved with something with the department as early as possible and push it through. Even a chart review for a retrospective cohort trial can be done over the summer between 1st/2nd year. This both helps establish that you are interested, teaches you about neurosurgery and the terms/procedures, and introduces you to the department. During the 4th year do sub-internships on the neurosurgery service at your home program and 1-3 away programs. In neurosurgery in particular these away rotations are important because the letter from the away program helps establish that you are a team player and a good fit. It's a small field and everybody knows everybody.

Residency: Each program structures it differently and it can vary widely, but in general the following applies.



Internship: Up to 6 months of neurosurgery. Some general surgery and electives (neurology, critical care, interventional neuroradiology).

PGY 2-6: A mix of junior resident in the unit, on the floor, consults. Depending on the model, some break the hospital in to services i.e. pediatrics, spine, cerebrovascular, trauma while others lump them together still others use an apprentice model where a resident is assigned an attending(s). For the most part juniors (PGY-2) do scut and seniors (PGY6) operate. Most programs have 1-2 years in the middle for electives and research time. This can either be protected from the call schedule, where you do not take call, or not where you are mixed in to the call schedule in varying ways (2 calls/month, weekends, etc.)

PGY 7: Chief year. Run the service/operate. Some programs have moved to having the chief be a junior faculty member with admitting privileges.

Call is very program dependent. Some are q3 for the junior years and others are q12.

Fellowship: Specialties include cerebrovascular, endovascular, spine, peripheral nerve, skull base/endoscopic, pediatrics, trauma, and functional. Depending on the structure, fellows get to pick cases over the chief, or are tasked to work with the chief and walk them through cases. Most take home call, sometimes they have admitting privileges.
This is GOLD
 
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For what it's worth, if you're into history but don't have the time to search for a good book, I'd recommend The Gene by Siddhartha Mukherjee and Sapiens by Yuval Noah Harari. Hillbilly Elegy and The Last Lecture by Randy Pausch aren't historical books per se (both are memoirs) but still belong. TBH I should be a professional book reviewer instead of a physician.

I'll have to take a look a these and get back to you!
 
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Sorry if you've addressed this previously, but how necessary/important are aways? I know there's some variation based on ambition/options, but if there was a rule, what would it be? Any important strategies when scheduling aways that are more or less important in neurosurgery (geography, size of program, etc)?
 
Also on the topic of aways - what would be some general rules of thumb for what to do/how to conduct yourself during away rotations. Also, what to look for when evaluating programs/deciding whether it's a good fit for you. Thanks!
 
How smart do you have to be to become a neurosurgeon

I'm still amazed they let me in! There are different kinds of smart. Neurosurgery requires a combination of many factors, including hard-work, drive, ambition, test-taking abilities, ability to interact with others/interview well and demonstrate your abilities. While I haven't been a resident in any other field, from what I hear from other residents, or recall from medical school, we, as a field, grant our residents an incredible amount of autonomy, early in training. The ability to work with others, convey the facts, succinctly, formulate an actionable and appropriate plan, and execute it are difficult to discern via CV or 20-minute conversation during interview day. At the end of the day, being a neurosurgeon, in itself may not be terribly difficult. I've had attendings say things like "we're just brain plumbers," or "I'm just a carpenter of the spine," or "we could teach a monkey to operate." Having the teach-ability, judgement, and balance of conservative management vs aggressive care is what makes a good neurosurgeon.
 
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Sorry if you've addressed this previously, but how necessary/important are aways? I know there's some variation based on ambition/options, but if there was a rule, what would it be? Any important strategies when scheduling aways that are more or less important in neurosurgery (geography, size of program, etc)?

Are away rotations absolutely necessary? No. I think I can recall of people who have matched without any. Do they help? Absolutely.

My opinion is that they are a fundamental part of both your education and the application process. For your education, you are able to see how other institutions function. The variety in medicine from simply the hospital structure, call schedule, the way they run the list, to run the OR, to actually do surgery varies vastly. As a resident and/or attending your ability to go around and see this is somewhat limited. Second, an away rotation is external validation of your application. It enables you to work closely with a group of neurosurgeons and be vetted. They report back to the community as a whole on your abilities, and in some way, we are able to construe where you would fall within the pool of applicants this year.

There really are not any rules, however I recommend to the students I work with several things. First, pick the number of away rotations you want to/can do (anywhere from 1 to 3). Then, look at the list of programs out there and create an arbitrary list of the most competitive and lessor competitive programs. Doing an away at a place that has a lot of students rotate there, and/or is very well regarded/competitive is a good validation rotation for your application. It may be out of your reach, but is a good trial by fire. Doing an away at a program that you think you would like, but is less traveled, may give you the opportunity to increase your relative value at that program. Geography does matter. If you do all of your rotations in one city, or even one region, on the interview trail you often will get pegged as wanting to go to that region. This can be rather difficult to overcome. Spreading them out may help in offsetting this prejudice. In the end though, it is how you sell yourself e.g. have a good reason for "why our program?" Simply stating something to the effect of "well California/NYC/Mississippi is great!" will not win over very many program directors. Finally, enjoy yourself! It is probably the most exciting time of your life for now, and absolutely goes by far faster than you think it is. You'll make some great friends, and meet a ton of nice and influential people. Neurosurgery is a small community, and they will be your colleagues for the rest of your life.
 
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Hey @neusu I have a question that I've always wanted to ask a neurosurgeon. I know that during medical school there are plenty of opportunities to do research and traditionally if you want to incorporate research into your work as a clinician you can do an MD/PhD. As a resident when you keep yourself up to date with research developments in your field is it mostly clinically related, or do you pay attention to any non-clinical research going on in neuroscience as well?

I ask this because I was a neuroscience major in undergrad and worked in a research lab that was incorporating optogenetics into our studies. While optogenetics is concentrated in animal research, it's implications in human pathology is huge such as epilepsy, parkinson's, etc. Essentially an engineer at MIT created a way to activate/deactivate neuronal firing in mice by using light stimulation directly in the brain by making neurons express light sensitive ion channels through a viral vector. What are your thoughts?
 
Hi @neusu, I was wondering if you could tell me a little about what cases a pediatric neurosurgeon would do? And what the most common case would be?
 
When it comes to physical requirements is there ways to accodomate in the OR? I am speaking from the point of view as someone post CES with Ehlers Danlos. My current job outside of school is 40 hours a week standing on my feet.
 
Also on the topic of aways - what would be some general rules of thumb for what to do/how to conduct yourself during away rotations. Also, what to look for when evaluating programs/deciding whether it's a good fit for you. Thanks!

This can be hard to explain in words, but basically be affable, available, and able (in that order). No one wants the subI who is a jerk and can't take a hint. I feel bad for the ones who don't get it, and I am sure I was as guilty as they are of stepping on someone's invisible toes. Needless to say, just be a hard worker and a good person and things should work out.
 
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Hey @neusu I have a question that I've always wanted to ask a neurosurgeon. I know that during medical school there are plenty of opportunities to do research and traditionally if you want to incorporate research into your work as a clinician you can do an MD/PhD. As a resident when you keep yourself up to date with research developments in your field is it mostly clinically related, or do you pay attention to any non-clinical research going on in neuroscience as well?

I ask this because I was a neuroscience major in undergrad and worked in a research lab that was incorporating optogenetics into our studies. While optogenetics is concentrated in animal research, it's implications in human pathology is huge such as epilepsy, parkinson's, etc. Essentially an engineer at MIT created a way to activate/deactivate neuronal firing in mice by using light stimulation directly in the brain by making neurons express light sensitive ion channels through a viral vector. What are your thoughts?

I try to read the articles in the major journals and keep abreast of other esoteric personal interests. For the most part, basic science is left at the door on your way in to residency. They are doing some great work with optogenetics, but it is still years before it will become clinically relevant. I know Ed Boyden at the MIT Media Lab, not sure if that is who you are referencing, but the whole group there is outstanding. There are a number of other groups across the country using these techniques. Only time will tell where/when it is applied to humans and how impacting it will be.
 
I try to read the articles in the major journals and keep abreast of other esoteric personal interests. For the most part, basic science is left at the door on your way in to residency. They are doing some great work with optogenetics, but it is still years before it will become clinically relevant. I know Ed Boyden at the MIT Media Lab, not sure if that is who you are referencing, but the whole group there is outstanding. There are a number of other groups across the country using these techniques. Only time will tell where/when it is applied to humans and how impacting it will be.

Thank you so much for taking the time to reply. I agree that we won't see optogenetics in its clinical applications for a while, if not decades. And yes I was referring to Ed Boyden who is a genius! Thank you for your insight as a resident, I hope your career is all you hope it to be!
 
Hi @neusu, I was wondering if you could tell me a little about what cases a pediatric neurosurgeon would do? And what the most common case would be?

Pediatric neurosurgeons generally operate on brain and spine pathology of children ranging from premature neonates to adults with diseases previously managed as children. There are some centers who are doing in-utero surgery for spina bifida.

My experience as a resident on the pediatric neurosurgery service was that there was a fair amount of trauma e.g. mild/moderate/severe non-operative traumatic brain injury and spine trauma management. Spinal dysraphisms were also not uncommon for tethered cord or the not very frequent myelomeningocele repair. Also Chiari malformation. There were a fair number of tumor cases, less common were epilepsy or vascular. Also, premature children are prone to intraventricular hemorrhage, so they are followed in the NICU. They may need shunting. We shunt a for a variety of reasons, so this tends to be a significant part of the experience. Finally, there are a fair number of children with spasticity that require intrathecal pumps.

The shunt/pump experience may seem disproportionate because one patient may require several admissions and/or surgeries. So for every one tumor that goes well, there may be a shunt infection that comes in for: explant/drain placement +/- revision, sit in the ICU for weeks until the infection clears, re-internalization.
 
When it comes to physical requirements is there ways to accodomate in the OR? I am speaking from the point of view as someone post CES with Ehlers Danlos. My current job outside of school is 40 hours a week standing on my feet.

Can you clarify accommodate for a physical requirement?

If you can stand for 40-hours a week I guess I am not seeing the issue. There was a student who applied, and matched, in the last cycle who had a spinal cord injury and was wheel-chair bound. In the past, I had worked with a surgeon who had a skiing accident, and surgery, for his fractured tibia. He was non-weight bearing on that limb but got around with a wheely thing he rested his bent knee on. In the OR, he had a pommel horse looking chair that lifted him up to the field.

So yes, many physical accommodations can be made. If you need a half-hour break every hour, or can't get by with less than 8-hours of sleep a night, that likely won't fly.
 
Love this thread @neusu. You're the best.

When you say you need publications to have a competitive application for Neurosurgery residencies, would you say being a first author in editorials and chapters in books count? I don't see how anyone could get published on 10 different papers during med school.


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Love this thread @neusu. You're the best.

When you say you need publications to have a competitive application for Neurosurgery residencies, would you say being a first author in editorials and chapters in books count? I don't see how anyone could get published on 10 different papers during med school.


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Glad to hear you enjoy this thread. Everything counts, but journal articles that are PubMed indexed are the most important. Reviews, editorials, and book chapters, while useful endeavors and nice CV padding, aren't exactly hard-hitting sciences. Likewise, you're a medical student, not exactly an authority on any particular issue (I presume), so your contributions are taken less seriously. Don't get me wrong, you may do all of the work, construct the manuscript, and simply have your PI sign off on it. Nonetheless, comparatively, your expert opinion is nil.

For those who publish 10+ papers in medical school, I have found a general algorithm for it. First and foremost, know early in medical school (e.g. first year). Second, find a group that is productive. Some of it may be riding the coat-tails of your colleagues or scrapping for anything that can be done. Another possibility is to make a meaningful clinical database that can be mined for various uses. In any event, working with a proactive, productive PI is also very helpful.
 
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Glad to hear you enjoy this thread. Everything counts, but journal articles that are PubMed indexed are the most important. Reviews, editorials, and book chapters, while useful endeavors and nice CV padding, aren't exactly hard-hitting sciences. Likewise, you're a medical student, not exactly an authority on any particular issue (I presume), so your contributions are taken less seriously. Don't get me wrong, you may do all of the work, construct the manuscript, and simply have your PI sign off on it. Nonetheless, comparatively, your expert opinion is nil.

For those who publish 10+ papers in medical school, I have found a general algorithm for it. First and foremost, know early in medical school (e.g. first year). Second, find a group that is productive. Some of it may be riding the coat-tails of your colleagues or scrapping for anything that can be done. Another possibility is to make a meaningful clinical database that can be mined for various uses. In any event, working with a proactive, productive PI is also very helpful.

Would you recommend finding a good PI before M1 and possibly even starting in the lab the summer before matriculating?

Also, I'm not sure if you've answered this already, but how is research in an unrelated field viewed when applying to residencies?
 
Glad to hear you enjoy this thread. Everything counts, but journal articles that are PubMed indexed are the most important. Reviews, editorials, and book chapters, while useful endeavors and nice CV padding, aren't exactly hard-hitting sciences. Likewise, you're a medical student, not exactly an authority on any particular issue (I presume), so your contributions are taken less seriously. Don't get me wrong, you may do all of the work, construct the manuscript, and simply have your PI sign off on it. Nonetheless, comparatively, your expert opinion is nil.

For those who publish 10+ papers in medical school, I have found a general algorithm for it. First and foremost, know early in medical school (e.g. first year). Second, find a group that is productive. Some of it may be riding the coat-tails of your colleagues or scrapping for anything that can be done. Another possibility is to make a meaningful clinical database that can be mined for various uses. In any event, working with a proactive, productive PI is also very helpful.

Any tips for identifying productive labs? Some PIs look productive on PubMed, but actually seem to just be writing a ton of solo reviews or small papers with PIs from other universities, other than getting their students names on papers.
 
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Would you recommend finding a good PI before M1 and possibly even starting in the lab the summer before matriculating?

Also, I'm not sure if you've answered this already, but how is research in an unrelated field viewed when applying to residencies?

I would recommend finding a PI before starting. During discussions on the project, make it clear that you will be doing your initial background reading and so forth during the first semester, but your #1 priority is making sure you do well in class. You need to understand the workload of medical school and how you can optimize your ability to learn and score well in your classes. Research is a luxury commitment. That being said, your learning in neurosurgery will help with your neuroscience block, so it's not for naught.

Finding a PI can be tricky, as most departmental websites are not exactly up to date nor do they typically provide specifics on ongoing projects. One easy way to determine if someone is active and productive is to to a quick pubmed search. The string I use is Lastname FI MI AND City (where FI is first initial and MI is middle initial and City is the city of the institution at which they practice). Finally, sometimes the PI themselves are a little too busy to really facilitate much with students. Look at the resident roster for your home program and do the same pubmed search, but this time for the residents. If they have a number of publications in an area in which you are interested, consider contacting them to see if and how you may help. Residents are generally much more approcahable, and though busier on paper, much more receptive to getting a student on board.

Research in an unrelated field counts, however it is less impressive. I think I have stated it in the past, but for the most part research establishes the following: 1) demonstrates understanding of the process of formulating a hypothesis, testing it, and communicating the results in a meaningful way that others will be able to understand 2) work ethic to sticking to a project 3) ability to deliver an end result. While again, research in other fields is less impressive, this is because we can't relate to it as directly. You could be a world expert on glaucoma, or esoteric skin rashes, but I don't deal with that. If, however, you publish on TBI, DBS, spine, tumor, SAH, etc, I deal with that on a daily basis, know the language, and can relate it to my practice.
 
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Any tips for identifying productive labs? Some PIs look productive on PubMed, but actually seem to just be writing a ton of solo reviews or small papers with PIs from other universities, other than getting their students names on papers.

I think I covered this in my last reply, but look at the by-lines for the publications. As you indicated, if they are on multi-center papers with few other people from your program, that may not be a good indicator.

One query that I would run in PubMed is Lastname FI MI AND city (where Latname is their last name, FI is the first initial, MI is middle initial, and city is the city of the program). Do this for several attendings. Likewise, look at the residents in the program. The latter tend to be a better representation of what is done in-house, and tend to be more approachable than the attendings anway. Further, they see students as great opportunities to be the work-horse and get the scut work for the project done.

Different residents take different mentalities with respect to authorship. Some adhere strictly to the school of thought that students gather information and don't do any of the intellectual work. Thus, you may be buried somewhere in the middle of the author order. Even worse, some see that work as not significant enough of a contribution to be on the manuscript, and thus, you merely attain an acknowledgement. This is more commonplace in basic science than clinical. Anyhow, some residents prefer to mentor students and have them both synthesize the information and author the manuscript. This tends to land you the coveted first author position, which when you are applying for residency, looks better.

Personally, when I work with students, I take the latter approach. Yes, some students really just want to be scut monkeys and get buried somewhere in the author order. Many, however, want to learn the process and earn that first author. Maybe I am crazy, but once I hit my mid-residency years I felt I had established my academic reputation enough that insisting on being first author was not necessary so I enjoyed seeing the med students who worked for it earn it. Then again, I got burned a several times early in my career where I put in the work and rightfully earned first author only to have the PI swoop in and take it because he felt it was going to be an important enough paper that he wanted the Lastname et al to be him.

The long and short of it is that much of the process is politcal, but expecting to work hard and not necessarily see results immediately is key. Having several ongoing efforts, where you can focus your time when one is needing attention helps maintain productivity. Finally, there are many many more medical students who say they are interested in research than those who actually are. It is in your best interest to pick a project in which you have actual interest so that you don't fizzle out and become yet another med student in the halls of lost efforts.

Hope this helps.
 
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What are the distinctions in practice between IR, vascular surgery, and endovascular neurosurgery? I'm currently doing a nsg summer program and find endovascular to be fascinating, and am wondering if the 9 years of training confers anything else besides the ability to perform open cases as well
 
If you wanted to do endovascular, it is much better than go Rads -> Neuro IR or Neuro -> Neuro IR.

(especially Rads -> IR if you wanted to have access to extra-cranial endovascular)
 
What are the distinctions in practice between IR, vascular surgery, and endovascular neurosurgery? I'm currently doing a nsg summer program and find endovascular to be fascinating, and am wondering if the 9 years of training confers anything else besides the ability to perform open cases as well

Endovascular neurosurgery focuses on carotid and intracranial disease. Interventional radiology is more broad and covers the whole body. To perform intracranial interventions, they generally have to do a neuro-IR super-fellowship. Vascular surgery performs open and endovascular procedures on the peripheral vasculature and carotid arteries. For the most part, this excluds ascending aorta. @mimelim could comment better on the role of the vascular surgeons, but from what I can tell they perform TEVAR and EVAR for aortic disease, and stenting or bypass for iliac/femoral/popliteal, make fistulas for dialysis access, and manage venous disease as well.
 
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What are the distinctions in practice between IR, vascular surgery, and endovascular neurosurgery? I'm currently doing a nsg summer program and find endovascular to be fascinating, and am wondering if the 9 years of training confers anything else besides the ability to perform open cases as well

There is a tremendous amount of potential overlap depending on your locale. Also would add in interventional cardiology and interventional nephrology into the mix. As this is a neuro oriented thread, I'll focus there and try to also comment on the training pathways since you mention them.

The reality is that as long as a hospital gives you privileges and people refer you patients, regardless of the direction you come from, you will be able to do carotid/interventional work. For example, at the hospital that I am at, you could have a neurosurgeon, neuro radiology (NIR), interventional cardiologist (IC) or vascular surgeon put a carotid stent into you, depending on how you came into the hospital, based on referral patterns. For example, if you come in as an acute stroke, go to the NICU and then are found to need intervention, NIR or neurosurgery would be the first to see you. If you are asymptomatic and have any type of heart troubles, you will most likely be brought in electively by your cardiologist. If you need anything else done while needing a stent, then most likely vascular surgery would either be primary on the procedure or at least involved. Those are one liners to describe complex arrangements, but I think that it is pretty accurate in most cases, at least where I am. The real distinction comes in what others generally don't do.

If all you want to do is endovascular work, in my opinion, you shouldn't go via neurosurgery. Even if you find the neuro procedures to be particularly interesting compared to other endo cases. I really think that you will find endo work elsewhere in the body to be equally or close to as stimulating and won't take you as long to get to. Also, something to consider, neurosurgery residency and vascular residencies are not only longer, but tend to be much more demanding than IM->Cards->IC or DR-> IR. If you have no intention of practicing open surgery, better from the get-go to go a different direction. In that regard... IR has a huge range of procedures that they perform, as do vascular surgeons. Monday, I have an EVAR followed by a fem-pop, followed by two leg angios. Tuesday I have 8 dialysis access cases. Wednesday I have another 7 dialysis access cases, Thursday morning is clinic, afternoon don't have anything and Friday I have vein clinic + 3 ablations. Variety++
 
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Im sorry if this was already asked and answered previously but does which medical school you attend affect your chances of getting a neurosurgery residency spot. Obviously there are plenty of factors but is medical school ranking/prestige factored into a competitive residency like this?
 
If you wanted to do endovascular, it is much better than go Rads -> Neuro IR or Neuro -> Neuro IR.

(especially Rads -> IR if you wanted to have access to extra-cranial endovascular)

This really depends on your goal in life and the practice environment where you ultimately end up.

For intracranial vascular procedures, as indicated, there are three pathways: Neurosurgery, Neurology, Neurointerventional Radiology. Neurosurgery is the longest, but most comprehensive for management of intracranial pathology. Neurology is the shortest, followed by Neurointerventional Radiology.

For the most part, you won't be doing catheter work all day every day in practice, so think about what you'd like to be doing when you're not in the angio suite. Do you want to be doing craniotomies or spine surgery? Then do neurosurgery. Do you want to round on stroke patients, titrate heparin drips, and give tpa/aspirin/plavix? Then do Neurology. Do you want to do peripheral vascular interventional procedures or sit in the reading room all day reading MRI and CT imaging? Then do Interventional Radiology.

Finally, the practice you join has a lot to do with it. The referral pattern for cases, and who the ER calls first has a lot to do with how busy you will be. Likewise, if you start as a neurosurgeon where stroke intervention and SAH are already owned by IR, you likely will be boxed out of that practice. As neurosurgeons, we offer the ability to be all-encompassing management of these diseases: e.g. a SAH that comes in, needs an EVD, admission to the ICU, aniogram, and ultimately surgical aneurym clipping involves one physician. Neither IR nor Neurology can do that.
 
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This really depends on your goal in life and the practice environment where you ultimately end up.

For intracranial vascular procedures, as indicated, there are three pathways: Neurosurgery, Neurology, Neurointerventional Radiology. Neurosurgery is the longest, but most comprehensive for management of intracranial pathology. Neurology is the shortest, followed by Neurointerventional Radiology.

For the most part, you won't be doing catheter work all day every day in practice, so think about what you'd like to be doing when you're not in the angio suite. Do you want to be doing craniotomies or spine surgery? Then do neurosurgery. Do you want to round on stroke patients, titrate heparin drips, and give tpa/aspirin/plavix? Then do Neurology. Do you want to do peripheral vascular interventional procedures or sit in the reading room all day reading MRI and CT imaging? Then do Interventional Radiology.

Finally, the practice you join has a lot to do with it. The referral pattern for cases, and who the ER calls first has a lot to do with how busy you will be. Likewise, if you start as a neurosurgeon where stroke intervention and SAH are already owned by IR, you likely will be boxed out of that practice. As neurosurgeons, we offer the ability to be all-encompassing management of these diseases: e.g. a SAH that comes in, needs an EVD, admission to the ICU, aniogram, and ultimately surgical aneurym clipping involves one physician. Neither IR nor Neurology can do that.
Thanks for your responses. Is this your PGY7 year? If so, are you pursuing any fellowships?
 
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Thanks for your responses. Is this your PGY7 year? If so, are you pursuing any fellowships?
Was just about to ask the same. @neusu I remember a few years back in the thread you mentioned being fond of cerebrovascular. Is that still a case?
 
There is a tremendous amount of potential overlap depending on your locale. Also would add in interventional cardiology and interventional nephrology into the mix. As this is a neuro oriented thread, I'll focus there and try to also comment on the training pathways since you mention them.

The reality is that as long as a hospital gives you privileges and people refer you patients, regardless of the direction you come from, you will be able to do carotid/interventional work. For example, at the hospital that I am at, you could have a neurosurgeon, neuro radiology (NIR), interventional cardiologist (IC) or vascular surgeon put a carotid stent into you, depending on how you came into the hospital, based on referral patterns. For example, if you come in as an acute stroke, go to the NICU and then are found to need intervention, NIR or neurosurgery would be the first to see you. If you are asymptomatic and have any type of heart troubles, you will most likely be brought in electively by your cardiologist. If you need anything else done while needing a stent, then most likely vascular surgery would either be primary on the procedure or at least involved. Those are one liners to describe complex arrangements, but I think that it is pretty accurate in most cases, at least where I am. The real distinction comes in what others generally don't do.

If all you want to do is endovascular work, in my opinion, you shouldn't go via neurosurgery. Even if you find the neuro procedures to be particularly interesting compared to other endo cases. I really think that you will find endo work elsewhere in the body to be equally or close to as stimulating and won't take you as long to get to. Also, something to consider, neurosurgery residency and vascular residencies are not only longer, but tend to be much more demanding than IM->Cards->IC or DR-> IR. If you have no intention of practicing open surgery, better from the get-go to go a different direction. In that regard... IR has a huge range of procedures that they perform, as do vascular surgeons. Monday, I have an EVAR followed by a fem-pop, followed by two leg angios. Tuesday I have 8 dialysis access cases. Wednesday I have another 7 dialysis access cases, Thursday morning is clinic, afternoon don't have anything and Friday I have vein clinic + 3 ablations. Variety++

Thanks for the clarification.
 
Im sorry if this was already asked and answered previously but does which medical school you attend affect your chances of getting a neurosurgery residency spot. Obviously there are plenty of factors but is medical school ranking/prestige factored into a competitive residency like this?

The medical school matters for several reasons 1) the prestige factor during applications 2) whether or not you have a home program 3) track record of solid students who make good residents.

1) Neurosurgeons are humans and naturally want bright shiny objects that will impress others. For medical students, these are the ones with big name schools. Does it make a huge difference? No. All other things being equal (two candidates with EXACTLY the same application, changing only the school), most likely the person with BRAND-NAME-SCHOOL will be considered stronger than the person with UNKNOWN-SCHOOL.

2) Having a home program is very helpful. It not only allows a medical student early exposure through research, shadowing, and rotations, but also serves as a launch point. Likewise, during applications, the home chairman and/or program director can advocate for students. Students from a school without a home program can and do match, they just have to facilitate much of this on their own.

3) There is a saying during match that "the devil you know is safer than the devil you don't know." We are conservative people, and prefer things we know, and thus know how to handle. If you look at the roster of programs, often you will see students from various years from the same school at the same program. This is because students from that school are a known quantity, and the quality of those students is appreciated by that program. While again, students from schools without a strong track record of creating neurosurgery residents can and do match, it is another question mark on the application. To the contrary, if you are at a school that has had very few, and/or a record of students who turn out to flail, it can, unfortunately, actually harm your application.
 
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What percentage of your cases would you say are emergencies? I once heard someone say neurosurg is like 50% emergency cases and I didn't know if they're just BSing. I suppose it's highly city dependent too.
 
Thanks for your responses. Is this your PGY7 year? If so, are you pursuing any fellowships?

Was just about to ask the same. @neusu I remember a few years back in the thread you mentioned being fond of cerebrovascular. Is that still a case?

I'd rather try to keep the veil of anonymity, since neurosurgery is such a small community. That being said, yes, I am interested in vascular, and yes I am somewhere in the range of senior resident/fellow/junior attending. I find the vascular and skull base anatomy and the pathologies we deal with to be the most fascinating and challenging. I do enjoy many other subspecialties in neurosurgery, but wanted to specialize in vascular.
 
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What percentage of your cases would you say are emergencies? I once heard someone say neurosurg is like 50% emergency cases and I didn't know if they're just BSing. I suppose it's highly city dependent too.

This varies on practice setting. For most private practice neurosurgeons, or even academic neurosurgeons, not on call, the rate is near 0%. Even for a level-I trauma center, much of what we do is non-operative. Likewise, we can park most things and wait to operate on an elective basis. Some things, can not wait (e.g. hematoma, infections, etc). True emergencies, compromise a relatively small part of most practices.
 
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The medical school matters for several reasons 1) the prestige factor during applications 2) whether or not you have a home program 3) track record of solid students who make good residents.

1) Neurosurgeons are humans and naturally want bright shiny objects that will impress others. For medical students, these are the ones with big name schools. Does it make a huge difference? No. All other things being equal (two candidates with EXACTLY the same application, changing only the school), most likely the person with BRAND-NAME-SCHOOL will be considered stronger than the person with UNKNOWN-SCHOOL.

2) Having a home program is very helpful. It not only allows a medical student early exposure through research, shadowing, and rotations, but also serves as a launch point. Likewise, during applications, the home chairman and/or program director can advocate for students. Students from a school without a home program can and do match, they just have to facilitate much of this on their own.

3) There is a saying during match that "the devil you know is safer than the devil you don't know." We are conservative people, and prefer things we know, and thus know how to handle. If you look at the roster of programs, often you will see students from various years from the same school at the same program. This is because students from that school are a known quantity, and the quality of those students is appreciated by that program. While again, students from schools without a strong track record of creating neurosurgery residents can and do match, it is another question mark on the application. To the contrary, if you are at a school that has had very few, and/or a record of students who turn out to flail, it can, unfortunately, actually harm your application.

What is considered a brand name school vs an unknown school? Does it have to be a t20?

Also I'm not sure if this was answered but would you mind sharing stats? MCAT and step 1, class rank, etc?
 
I've heard from an orthopedic spinal surgeon that deadlifting can be pretty terrible for your spine–what's your take on this?

On another note, what's your tech situation setup? Laptop, etc. Do you have a battle station at your office? Any software you can recommend for organization/management?
 
Hi there, this is a great platform for students/graduates looking for more information on Neurosurgery.
I am an IMG from India. I would be applying to Neurology this year. I am really interested in pursuing Neurosurgery in US, I have decent USMLE Step scores 245-250 on both. Somehow, I wasn't really confident of my credentials to get into Neurosurgery program. My plan is do get into Neurology residency next July, complete 4 years of Neurology, do research work along with Neurology residency and apply for Neurosurgery in my 4th year of Neurology residency. I feel it would make me a stronger and more complete candidate for Neurosurgery, having gained 4 years of US Residency experience would wash all my IMG stains. Do you think that's a good plan, also I would be 34 by the time I complete my Neurology residency. Would I be too old to pursue Neurosurgery after that. For me age is not the limit, it's my dream to see myself as Neurosurgeon in US. I hope PD's don't look down on my age. Being an IMG, I know I would always be steps behind an American Grad. Thanks
 
Also I don't have any US based research experience or USCE to support my application for Neurosurgery. Neurology is not that difficult to get into in US, requiring minimum to no USCE or research. That's why I have chosen this track, Neurology 4 years followed by Neurosurgery
 
Hi there, this is a great platform for students/graduates looking for more information on Neurosurgery.
I am an IMG from India. I would be applying to Neurology this year. I am really interested in pursuing Neurosurgery in US, I have decent USMLE Step scores 245-250 on both. Somehow, I wasn't really confident of my credentials to get into Neurosurgery program. My plan is do get into Neurology residency next July, complete 4 years of Neurology, do research work along with Neurology residency and apply for Neurosurgery in my 4th year of Neurology residency. I feel it would make me a stronger and more complete candidate for Neurosurgery, having gained 4 years of US Residency experience would wash all my IMG stains. Do you think that's a good plan, also I would be 34 by the time I complete my Neurology residency. Would I be too old to pursue Neurosurgery after that. For me age is not the limit, it's my dream to see myself as Neurosurgeon in US. I hope PD's don't look down on my age. Being an IMG, I know I would always be steps behind an American Grad. Thanks

Neurology will not make you a stronger nor more complete candidate for Neurosurgery.

I think it is a terriblep lan.

You will not be too old at 34.

Check out the Neurosurgery thread for a better route to Neurosurgery.
 
What is considered a brand name school vs an unknown school? Does it have to be a t20?

Also I'm not sure if this was answered but would you mind sharing stats? MCAT and step 1, class rank, etc?

I haven't really checked the US news lately to know which schools are in the top 20 or not. What I mean by brand name, is a school most people would recognize just by hearing the name. Likewise, unknown may be new, or just a less well known school.

I think the answers on stats are earlier in the thread. In all honesty, I'd have to check what my MCAT was as it has been a while. I do recall my school didn't rank students. When it comes to residency, MCAT is irrelevant. Class rank does count to some individuals, but every school is different with respect to whether they rank or not, or how it is reported in the Dean's letter, so it is not terribly important.
 
I haven't really checked the US news lately to know which schools are in the top 20 or not. What I mean by brand name, is a school most people would recognize just by hearing the name. Likewise, unknown may be new, or just a less well known school.

I think the answers on stats are earlier in the thread. In all honesty, I'd have to check what my MCAT was as it has been a while. I do recall my school didn't rank students. When it comes to residency, MCAT is irrelevant. Class rank does count to some individuals, but every school is different with respect to whether they rank or not, or how it is reported in the Dean's letter, so it is not terribly important.

What's your take on Robert Spetzler retiring from Barrow, and Michael Lawton being his replacement? Huge loss for UCSF.
 
What's your take on Robert Spetzler retiring from Barrow, and Michael Lawton being his replacement? Huge loss for UCSF.
Also, does anyone actually use the Spetzler-Ponce scale?
 
I've heard from an orthopedic spinal surgeon that deadlifting can be pretty terrible for your spine–what's your take on this?

On another note, what's your tech situation setup? Laptop, etc. Do you have a battle station at your office? Any software you can recommend for organization/management?

Strength training, when done with proper form, is good for strengthening muscle and bones, including the spine. The issue with things like squats and deadlifts, is people use bad form, or try to do too much weight, and end up with injuries. Therapy can help with recovery, but two things to consider: 1) as we grow older recovery takes longer and longer and is less likely to return to prior baseline 2) injured tissue is never as "good" as the pre-injured tissue.

I do have a battle battle station, both at my home office and my work office. At work I have a 8-core processor with 32 gb RAM and a Titan XP running two displays. At home I have another 8-core i7 with 64 gb RAM and 2x 980 Ti running two 4k displays and two 1080p displays. I typically run Windows 10, but have them set up to dual boot Linux and MacOS if I need those for any reason. I never really find the organizational software to actually help much, so I tend to have a routine for where I keep things and how I track changes. Moreover, a lot of the software that is purportedly supposed to organize/manage is buggy and bloated in my assessment (e.g. Endnote, Word, etc.).
 
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Hi there, this is a great platform for students/graduates looking for more information on Neurosurgery.
I am an IMG from India. I would be applying to Neurology this year. I am really interested in pursuing Neurosurgery in US, I have decent USMLE Step scores 245-250 on both. Somehow, I wasn't really confident of my credentials to get into Neurosurgery program. My plan is do get into Neurology residency next July, complete 4 years of Neurology, do research work along with Neurology residency and apply for Neurosurgery in my 4th year of Neurology residency. I feel it would make me a stronger and more complete candidate for Neurosurgery, having gained 4 years of US Residency experience would wash all my IMG stains. Do you think that's a good plan, also I would be 34 by the time I complete my Neurology residency. Would I be too old to pursue Neurosurgery after that. For me age is not the limit, it's my dream to see myself as Neurosurgeon in US. I hope PD's don't look down on my age. Being an IMG, I know I would always be steps behind an American Grad. Thanks

Apply to neurology if you are interested in being a neurologist; it likely won't help in obtaining neurosurgery residency. Do you have any research at this point? If not, it might benefit to spend time at a center in the US and working with a department here doing research.
 
I do have a battle battle station, both at my home office and my work office. At work I have a 8-core processor with 32 gb RAM and a Titan XP running two displays. At home I have another 8-core i7 with 64 gb RAM and 2x 980 Ti running two 4k displays and two 1080p displays. I typically run Windows 10, but have them set up to dual boot Linux and MacOS if I need those for any reason.

Damn, son.
 
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Also I don't have any US based research experience or USCE to support my application for Neurosurgery. Neurology is not that difficult to get into in US, requiring minimum to no USCE or research. That's why I have chosen this track, Neurology 4 years followed by Neurosurgery

Research can be based anywhere, so long as it is published in respectable journals. If it's not published and pubmed index, you might as well not have done it. Clinical experience is also important, can you do a month or more of away rotations or observation? This could be combined with a US research experience. In any case, doing an entire neurology residency is ill advised. Most neurosurgeons would have two issues 1) training spots are limited and doing so would remove a potential practicing neurologist from existence 2) the fields are so vastly different it doesn't necessarily apply.

That being said, I do know of at least one or two neurosurgeons who did another residency (orthopedics, neurology ent), so it's not entirely prohibitive.
 
What's your take on Robert Spetzler retiring from Barrow, and Michael Lawton being his replacement? Huge loss for UCSF.

Drs. Spetzler and Lawton are both very accomplished surgeons and have each made an impact on the field. I was fortunate enough to meet each of them on several occasions and they are both all around spectacular people. Dr. Lawton has huge shoes to fill, and it is certainly a loss for UCSF. Even so, it creates an opportunity for growth and another surgeon to take that role.
 
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